Clindamycin
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Trade Name
Cleocin, Cleocin T (topical); generic clindamycin hydrochloride (oral/IV), clindamycin phosphate (topical/injectable)
Classification
Lincosamide antibiotic
Dosage/Route
- * Dosage:
- – Capsules: 75 mg, 150 mg, 300 mg
- – Injection: 300 mg/mL, 600 mg/mL, 900 mg/mL
- – Topical: 1% gel, lotion, solution
- – Vaginal cream: 2%
- * Route: Oral (PO), intravenous (IV), intramuscular (IM), topical, vaginal
Usual Dosage
- * Adults:
- – PO: 150-450 mg every 6 hours (QID); max 1.8 g/day
- – IV/IM: 600-1200 mg/day divided q6-8h; max 2.7 g/day
- – Topical: Apply 1% BID to affected area (acne)
- – Vaginal: 100 mg cream intravaginally at bedtime for 7 days
- * Children:
- – PO: 8-20 mg/kg/day divided q6-8h
- – IV/IM: 20-40 mg/kg/day divided q6-8h
- * Duration: 7-14 days (infection-specific)
Mechanism of Action
Binds to 50S ribosomal subunit, inhibiting bacterial protein synthesis. Bacteriostatic (sometimes bactericidal) against gram-positive (e.g., Streptococcus, Staphylococcus, including some MRSA) and anaerobes (e.g., Bacteroides); no gram-negative activity
Side Effects & Adverse Effects
- * Side Effects: Diarrhea, nausea, rash, metallic taste (PO)
- * Adverse Effects:
- – Clostridioides difficile-associated diarrhea (CDAD; boxed warning)
- – Hypersensitivity (rash, anaphylaxis)
- – Hepatotoxicity (rare; elevated LFTs)
- – IV: Thrombophlebitis; IM: Injection site pain
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor GI symptoms (severe diarrhea = CDAD risk)
- – Assess liver function, allergy history (cross-reactivity rare with penicillin)
- – IV: Dilute to ≤18 mg/mL, infuse over 10-60 min (per dose); avoid rapid push
- – PO: Give with full glass of water to prevent esophageal irritation
- * Teachings:
- – Finish full course; take at even intervals (e.g., 6 AM, noon, 6 PM, midnight)
- – Report bloody diarrhea, rash, or yellowing
- – Topical: Apply thinly, avoid eyes; vaginal: Use at bedtime, avoid intercourse
- – Capsules: Don’t refrigerate; take with food if GI upset
Indication for This Patient
- * Bacterial infections:
- – Skin/soft tissue (e.g., cellulitis, abscess; including MRSA)
- – Respiratory (e.g., pneumonia, anaerobes)
- – Bone/joint, pelvic infections
- * Acne (topical)
- * Bacterial vaginosis (vaginal)
Time
- * Timing: PO/IV: Every 6-8 hours; Topical: BID; Vaginal: bedtime
- * Onset: Symptom relief in 1-3 days
- * Duration: 7-14 days (systemic); weeks (topical)
